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Paluku JL, Bartels SA, Kasereka JM, Aksanti BK, Kamabu EM, Mukuku O, Tsongo ZK, Wembonyama SO, Mpoy CW, Juakali JS. HEAL Africa score to predict failure of surgical repair of obstetric urethro-vaginal fistula in the Democratic Republic of the Congo. BMC Womens Health 2024; 24:111. [PMID: 38341554 PMCID: PMC10858488 DOI: 10.1186/s12905-024-02948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Obstetric fistula (OF) repair surgery aims to restore the anatomical and functional integrity of the urinary tract, allowing affected women to regain their dignity and quality of life. However, in some cases, this surgical repair may fail. The objective of this study was to develop a predictive score to identify factors associated with the failure of surgical repair of obstetric urethro-vaginal fistula (FSROUVF) in the Democratic Republic of the Congo (DRC). METHODS This is an analytical cross-sectional study of 358 patients with obstetric urethro-vaginal fistula (OUVF) who received surgical repair. We conducted bivariate and multivariate analyses. Score discrimination was assessed using the receiver operating characteristic (ROC) curve, C-index, and score calibration according to the Hosmer-Lemeshow test. RESULTS Surgical repair of OUVF failed in 24.86% of cases (89/358). After logistic modelling, 6 criteria predicted FSROUVF: the use of intravaginal indigenous products (AOR = 3.59; 95% CI: 1.51-8.53), the presence of fibrosis (AOR = 6.37; 95% CI: 1.70-23.82), the presence of 2 or more fistulas in the same patient (AOR = 7.03; 95% CI: 3.14-15.72), the total urethral damage (AOR = 3.29; 95% CI: 1.36-7.95), the fistula size > 3 cm (AOR = 5.65; 95% CI: 2.12-15.01), and the postoperative infection (AOR = 351.10; 95% CI: 51.15-2409.81). A score of 0 to 14 was obtained, with a value ≤5 points indicating a low risk of FSROUVF, a value between 6 and 8 indicating a moderate risk, and a value ≥9 points corresponding to a high risk of FSROUVF. The area under the ROC curve of the score is 0.938 with a sensitivity of 60.67%, a specificity of 96.28%, a positive predictive value of 84.38%, and a negative predictive value of 88.10%. CONCLUSION We report a FSROUVF rate in the DRC approaching a quarter of operative patients. Predictors of failure included fibrosis, presence of 2 or more fistulas, total urethral involvement, fistula size greater than 3 cm, postoperative infection, and use of intravaginal indigenous products. These factors are constitutive of the HEAL Africa score, which once validated, may have value in pre-operative counselling of patients. This study could be valuable for policy and strategies to address the problem of OUVF in the DRC and in resource limited settings more generally.
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Affiliation(s)
- Justin Lussy Paluku
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Goma, Goma, Democratic Republic of the Congo.
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo.
| | - Susan A Bartels
- Departments of Emergency Medicine and Public Health Sciences, Queen's University, Kingston, Canada
| | - Jonathan Ml Kasereka
- Department of Orthopedics and Trauma, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Barthelemy Kasi Aksanti
- Department of Obstetrics and Gynecology, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Eugénie Mukekulu Kamabu
- Department of Internal Medicine, HEAL Africa Hospital, Goma, Democratic Republic of the Congo
| | - Olivier Mukuku
- Institut Supérieur des Techniques Médicales, Lubumbashi, Democratic Republic of the Congo
| | - Zacharie Kibendelwa Tsongo
- Department of Internal Medicine, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
| | - Stanis Okitotsho Wembonyama
- Department of Pediatrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
- Department of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Charles Wembonyama Mpoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Jeannot Sihalikyolo Juakali
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Kisangani, Kisangani, Democratic Republic of the Congo
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Thompson JL, Liuti T, Albuquerque C, Murgia D. Congenital Urethrovaginal Fistula with Blind-Ending Vagina in a Female Pseudohermaphrodite Dog with Urinary Incontinence. J Am Anim Hosp Assoc 2021; 57:469184. [PMID: 34370856 DOI: 10.5326/jaaha-ms-7114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 11/11/2022]
Abstract
An 8 mo old male Doberman pinscher was referred for investigation of persistent urinary incontinence. Physical examination revealed urine leakage and abnormal external genitalia. A computed tomography scan identified a large fluid-filled cavity extending from the caudoventral abdomen displacing the colon and urinary bladder. No retained testicles were identified. A retrograde urethrogram study found a linear communication, cranial to the pubic brim between the urethra to the fluid-filled cavity (fistula). Exploratory celiotomy was performed, and an entire female reproductive tract with a blind-ending vagina and a urethrovaginal fistula was found. En bloc gonad hysterectomy was performed, the fistula was transected, and a careful urethral reconstruction was performed. The urinary incontinence resolved immediately after surgery, and no complications were reported. Mild urinary incontinence recurred 4 days following patient discharge, and a urine bacterial culture was positive for Klebsiella spp. An antibiotic course was prescribed, and the incontinence fully resolved. Congenital urogenital abnormalities should always be considered in young animals presenting with urinary incontinence. Here, a young female pseudohermaphrodite dog with a naturally occurring congenital urethrovaginal fistula is described. Exploratory surgery was required for definitive diagnosis and surgical intervention yielded a good medium-term outcome with resolution of clinical signs.
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Repair of Iatrogenic Urethral and Bladder Neck Injury Due to Missed Diagnosis of Mayer-Rokitansky-Küster-Hauser Syndrome. Urology 2019; 134:213-216. [PMID: 31560918 DOI: 10.1016/j.urology.2019.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022]
Abstract
Mayer-Rokitansky-Küster-Hauser syndrome is a congenital malformation disorder resulting in agenesis of the proximal vagina, absence of cervix, and variable development of the uterus. This report describes the repair of a complex iatrogenic urethrovaginal injury due to a missed diagnosis of Mayer-Rokitansky-Küster-Hauser. Our treatment utilized a primary urethroplasty through a transvaginal approach with bladder neck reconstruction and a Martius flap for secondary coverage. Urinary continence was restored postoperatively.
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Kumar M, Pandey S, Goel A, Sharma D, Garg G, Aggarwal A. Spectrum of urologic complications in obstetrics and gynecology: 13 years' experience from a tertiary referral center. Turk J Urol 2018; 45:212-217. [PMID: 30484765 DOI: 10.5152/tud.2018.92072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the patterns of presentation and management for urologic complications of obstetrics and gynecology in the form of genitourinary fistulas at a tertiary referral center and highlight the social issues associated with them. MATERIAL AND METHODS We conducted this retrospective study analyzing 311 patients with genitourinary fistulas after obstetric and gynecologic surgeries between January 2005 and January 2018. We recorded the patients' characteristics and area of residence and then analyzed the etiology, surgical management and success rates by grouping the patients into four types of genitourinary fistulas. The primary end point of success was patient being leak free. RESULTS Majority of patients (90.4%) were from rural areas. The distribution of genitourinary fistulas in descending order was vesicovaginal (79.7%), ureterovaginal (11.8%), urethrovaginal (10.2%) and vesicouterine fistulas (2.6%). The mean time to presentation was 25.80±48.69 days with a wide range of 10 days to 360 months. The most common etiology was obstructed labour (58.5%) followed by abdominal hysterectomy (32.7%). For vesicovaginal fistulas the route to be used for repair depended on surgeon's preference and both transabdominal and transvaginal routes had almost equal success rates. The success rate of laparoscopic vesicovaginal fistula repair was 89.4% and all (100%) laparoscopic ureteroneocystostomies were successful. CONCLUSION Genitourinary fistulas especially due to obstructed labour are still common in developing world showcasing the problem of inequitable distribution of healthcare. The surgical treatment approach depends on the surgeon's familiarity with the said procedure although versatility is required.
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Affiliation(s)
- Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
| | - Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Apul Goel
- Department of Urology, King George's Medical University, Lucknow, India
| | - Deepanshu Sharma
- Department of Urology, King George's Medical University, Lucknow, India
| | - Gaurav Garg
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, India
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Chodisetti S, Boddepalli Y, Kota MR. Concomitant repair of stress urinary incontinence with proximal urethrovaginal fistula: Our experience. Indian J Urol 2016; 32:229-31. [PMID: 27555683 PMCID: PMC4970396 DOI: 10.4103/0970-1591.185097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Proximal urethrovaginal fistula (UVF) located close to the bladder neck may cause extensive sphincter damage and is usually associated with continuous incontinence, which may mask the associated stress urinary incontinence (SUI). Simultaneous correction of SUI avoids a second surgery for SUI, which needs dissection in ischemic fields and carries a high risk of failure. The aim of this study is to describe our technique of concomitant repair of SUI with proximal UVF and our results. METHODS Between July 2010 and August 2014, 14 patients underwent UVF repair in Jackknife position by the interposition of a Martius flap and simultaneous correction of SUI by modified McGuire pubovaginal autologous fascial sling. The procedure was carried out a minimum of 3 months of presentation and after detailed preoperative evaluation. RESULTS After a mean follow-up of 28 months, all 14 patients were continent. None of the patients developed recurrence of the UVF. Two patients presented with retention immediately after catheter removal and clean intermittent catheterization training was given to both of them. Two patients became pregnant during the follow-up period and were advised cesarean section near term. CONCLUSIONS Repair of proximal UVF and correction of SUI can be performed in the same session to avoid the operation in an ischemic field.
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Affiliation(s)
- Subbarao Chodisetti
- Department of Urology, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Yogesh Boddepalli
- Department of Urology, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh, India
| | - Malakonda Reddy Kota
- Department of Urology, Andhra Medical College, King George Hospital, Visakhapatnam, Andhra Pradesh, India
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Shirvan MK, Alamdar DH, Ghorifi A, Rahimi HR. A Novel Treatment for Urethrovaginal Fistula: Autologous Platelet-Rich–Plasma Injection and Platelet-Rich–Fibrin-Glue Interposition. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2013.0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maliheh Keshvari Shirvan
- Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryoush Hamidi Alamdar
- Stem Cell and Regenerative Medicine Research Group, Department of Clinical Biochemistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ghorifi
- Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Rahimi
- Student Research Committee, Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Walker KF, Dasgupta J, Cust MP. A neglected shelf pessary resulting in a urethrovaginal fistula. Int Urogynecol J 2011; 22:1333-4. [PMID: 21468736 DOI: 10.1007/s00192-011-1423-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 03/22/2011] [Indexed: 11/28/2022]
Abstract
Vaginal pessaries are safe, simple and effective treatment for pelvic organ prolapse. However, they must be fitted and followed-up correctly as serious complications can arise when pessaries are neglected. In this case report, we present the first reported case of a urethrovaginal fistula due to a neglected shelf pessary.
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Affiliation(s)
- Kate F Walker
- Derby Royal Hospital, Uttoxeter Road, Derby, DE22 3NE, UK.
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Rectourinary fistula after radical prostatectomy: review of the literature for incidence, etiology, and management. Prostate Cancer 2011; 2011:629105. [PMID: 22110993 PMCID: PMC3216010 DOI: 10.1155/2011/629105] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 12/10/2010] [Accepted: 01/07/2011] [Indexed: 12/11/2022] Open
Abstract
Although rectourinary fistula (RUF) after radical prostatectomy (RP) is rare, it is an important issue impairing the quality of life of patients. If the RUF does not spontaneously close after colostomy, surgical closure should be considered. However, there is no standard approach and no consensus in the literature. A National Center for Biotechnology Information (NVBI) PubMed search for relevant articles published between 1995 and December 2010 was performed using the medical subject headings “radical prostatectomy” and “fistula.” Articles relevant to the treatment of RUF were retained. RUF developed in 0.6% to 9% of patients after RP. Most cases required colostomy, but more than 50% of them needed surgical fistula closure thereafter. The York-Mason technique is the most common approach, and closure using a broad-based flap of rectal mucosa is recommended after excision of the RUF. New techniques using a sealant or glue are developing, but further successful reports are needed.
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Estevez JP, Colin P, Lucot JP, Collinet P, Cosson M, Boukerrou M. Fistules urétrovaginales après cure d’incontinence urinaire d’effort par bandelettes sous-urétrales. À propos de deux cas et revue de la littérature. ACTA ACUST UNITED AC 2010; 39:151-5. [DOI: 10.1016/j.jgyn.2009.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Revised: 11/12/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
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Abstract
PURPOSE OF REVIEW A variety of fistulas occur involving the lower urinary tract with adjacent organs namely the vagina, uterus, rectum and colon. Most of these arise out of surgical complications and contribute significantly to the morbidity of the procedures. Surgical reconstruction remains the mainstay in the management. This article reviews the use of minimal-access procedures in reconstruction of lower urinary tract fistulas focusing on the bladder. RECENT FINDINGS Recently, numerous reports of laparoscopic and robot-assisted surgical repair of these fistulas have shown that these techniques can be used with efficacy and safety with added advantages of short hospital stay, reduced morbidity associated with surgical incision and lower blood loss. Robot-assisted surgery has the advantage of facilitating intracorporeal suturing, making laparoscopic reconstruction easier. However, the steep learning curve and the high cost of robotic surgery are limiting factors. SUMMARY Prevention of lower urinary tract fistula requires improvement in the quality and technique of surgery and minimizing surgical errors. Minimal access procedures offer surgical treatment with low morbidity but with higher cost. Open surgical repair is being used widely for treating these fistulas at this time, worldwide.
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Current world literature. Curr Opin Obstet Gynecol 2009; 21:450-5. [PMID: 19724169 DOI: 10.1097/gco.0b013e3283317d6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Urethrovaginal fistula repair. Curr Urol Rep 2009; 10:321-5. [PMID: 19709476 DOI: 10.1007/s11934-009-0064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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